Sep 06

Hip Replacement

By: Kathy


Less invasive procedures

You’ve battled hip joint pain for years, but it just keeps getting worse.  Your doctor says it’s time to consider hip joint replacement.  Trading in the pain for a new hip joint sounds appealing.  But the prospect of a long recovery – one that could take several months and may include a couple of weeks in a nursing care facility – isn’t appealing at all.

Hip replacement is one of the most common orthopedic procedures done.  And, historically, it requires a lengthy recovery.  But newer, minimally invasive hip replacement techniques are changing that.  People are returning home within a few days of surgery, and they generally have much less pain.  In addition, they’re usually able to get on with their regular daily activities much sooner than if they’d had a more traditional hip replacement.

Although the new procedures still aren’t widely available and aren’t for everyone, they do appear to offer promising results.

Inside your hip joint

When the cartilage in your hip is damaged or affected by disease – typically osteoarthritis – movement of the hip joint can be painful.  Most hip replacements are done because the joint was damaged by osteoarthritis.  Other reasons include hip fracture, rheumatoid arthritis, loss of bone from insufficient blood supply, resulting in avascular necrosis and bone tumor.

The traditional surgery for total hip replacement is done under general or regional anesthesia.  Typically, an 8 inch to 10 inch incision is required over the side of the hip.  Muscles, ligaments and tendons are separated to get at the joint.  The surgeon can then remove diseased or damaged bone and tissue from the joint before putting an artificial socket in place.  The top end of the femur is hollowed out so that a metal stem with an attached ball can be inserted in the bone.

Generally, you can expect to spend three to five days in the hospital after a traditional total hip procedure. Hip pain usually subsides within the first couple of weeks, but it can take up to three months to regain full strength and stamina.

Outcomes for traditional total hip replacement are excellent.  Well over 95 percent of procedures result in marked improvement in pain and hip joint function.

New techniques

In recent years, orthopedic surgeons at Mayo Clinic and various medical centers around the country have been developing less invasive and minimally invasive techniques to replace hip joints.  Some surgeons are doing “mini-hips” through one relatively small incision – about 3 1/2 inches.  Others use two incision techniques with even shorter incisions.  Recovery times are reduced and there’s typically an earlier retrun of muscle strength and stamina.

Accessing the hip joint through two smaller incisions allows surgical and post surgical care are being made to support these newer hip replacement procedures:

Modified anesthesia ~ Pain management can be done using sedation and by blocking sensation in a particular region (regional block), thus limiting the use of narcotic medications that can lead to confusion, drowsiness and nausea, which can interfere with the start of physical therapy.

Stepped up physical therapy ~ The use of narcotic painkillers is minimized.  These changes and the newer hip replacement techniques usually reduce hospital stays to one to three days.  Surgeons doing more traditional hip replacements have found that hospital stays also can be reduced with modifications in anesthesia techniques, pain management and physical therapy.

Not for everyone

Because these less invasive hip replacement procedures are relatively new, there are no studies demonstrating long term outcomes.  For now, these newer, less invasive procedures aren’t widely available.  Your surgeon is in the best position to determine if you’re a candidate for one of these procedures.  Less invasive approaches to hip replacement may be ruled out if you have:  marked hipbone deformity, a completely dislocated hip, marked obesity or had previous hip replacemnt.

From a surgeon’s standpoint, the “mini-hips” and two incision procedures are much more technically demanding than are the more traditional total hip replacement procedures.

Smaller incisions can make it more difficult to see the actual joint area.  There also are possible complications involved with less invasive procedures, such as dislocated hips, bone fractures, and nerve and blood vessel injuries.

When to consider hip replacement

If you frequently experience any of the following related to a hip joint, talk with your doctor about the possibility of hip joint replacement:  Pain that keeps you awake at night, difficulty using stairs, difficulty standing from a seated position, little or no relief from pain relievers or pain that keeps you from activities that you enjoy.

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